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題名 | 疑似持弓獵人症候群併發陣發性中樞性前庭功能障礙=Probable Bow-Hunter Syndrome with Paroxysmal Central Vestibulopathy |
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作者姓名(中文) | 陳建志; 陳登郎; 林毓慧; | 書刊名 | 臺灣耳鼻喉頭頸外科雜誌 |
卷期 | 51:3 2016.07-09[民105.07-09] |
頁次 | 頁151-159 |
分類號 | 416.861 |
關鍵詞 | 持弓獵人症候群; 椎基底動脈循環不全; 陣發性姿態性眩暈; 中風風險; 中樞性眩暈; Bow-Hunter syndrome; Vertebrobasilar insufficiency; Paroxysmal positional vertigo; Stroke risk; Central vertigo; |
語文 | 中文(Chinese) |
中文摘要 | 背景:持弓獵人症候群又稱之為轉頭性椎動脈症候群,顧名思義為射箭者在拉弓瞄準獵物準備射擊時,因頭須轉向注視側,引發了椎基底動脈循環不全,產生腦幹或小腦症狀。方法:自2005年迄今,診治過共計6名疑似該症候群的患者(4女2男),平均年齡58歲(範圍37-88歲)。回顧這些患者的系統性疾病、誘發因素、主要症狀、眼振電圖檢查、確診病因及治療方法。結果:系統性疾病為高血壓(2/6)與高血脂症(1/6),誘發因素主要為頭向右轉(5/6);主要誘發症狀為眩暈(3/6)與頭暈(3/6);主要會出現異常的眼振電圖為視運動性眼振(4/6)、兩耳溫差測試(2/6)、慢速視標追跡(2/6)和快速二點交互(1/6)檢查。確診病因為單側椎動脈發育不全(3/6)、椎動脈狹窄(1/6)與後顱窩循環之對半分支(2/6);有半數患者(3/6)亦同時罹患腦幹梗塞。建議採取口服抗血小板劑治療(5/6),並避免誘發動作。結論:持弓獵人症候群臨床上並不多見,大多容易被誤認為良性陣發性姿態性眩暈症,其實是血管性病變所致之「中樞性」眩暈,足以是一種「惡性陣發性姿態性眩暈症」,對於疑似個案,當提高警覺以避免發生缺血性腦梗塞的風險。 |
英文摘要 | BACKGROUND: Bow-Hunter's syndrome (BHS) is also called rotational vertebral artery syndrome, and implies archery bow aimed at those who prey ready to shoot, because the hunter should turned the head to one side to look, causing vertebrobasilar insufficiency so resulting in the brainstem or cerebellar symptoms. METHODS: Since 2005, there have been 6 patients (4 women and 2 men) highly suspective of BHS. They were aged 58 years in average (range: 37-88). Their systemic disease, inducing factors, major symptoms, electronystagmographies, etiologies and treatments were reviewed. RESULTS: The systemic diseases included hypertension (2/6) and hyperlipidemia (1/6). The major inducing factors were rightward head rotation (5/6). The major symptoms were whirling vertigo (3/6) and dizziness (3/6). The major abnormal electronystagmographies were optokinetic nystagmuses (4/6), caloric test (2/6), pursuits (2/6) and saccades (1/6). The etiologies included unilateral vertebral arterial insufficiencies (3/6), vertebral arterial stenosis (1/6) and dichotomies of posterior circulations (2/6). Half of them (3/6) were also diagnosed with brainstem infarction. Oral antiplatelets and avioding inducing factors were recommended (5/6). CONCLUSIONS: BHS is clinically rare, and mostly misdiagnosed with benign paroxysmal positional vertigo. BHS is actually vascular diseases with central vertigo, and is a kind of "malignant paroxysmal positional vertigo" due to the risk of ischemia stroke. |
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